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General NPI Number Information
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NPI Number | 1649864257
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Entity Type | Individual
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Provider Name | JUSTIN M BURGOS PTA
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Gender | Male
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Dates
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Enumeration Date | 02/24/2021
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Last Update Date | 12/06/2025
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Provider Practice Location Address
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Address Line | 2418 E SEMORAN BLVD
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City | APOPKA
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State | FL
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Zip | 32703-5805
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Country | US
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Telephone | 407-464-0210
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Fax |
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Provider Business Mailing Address
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Address Line | 997 E 10TH ST
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City | APOPKA
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State | FL
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Zip | 32703-5402
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Country | US
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Telephone | 956-463-0027
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 30326
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License Number State | FL
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